Human immunodeficiency virus (HIV) positive women have a greater likelihood of developing cervical cancer than HIV-negative women. While cervical cancer screening guidelines for women continue to be updated, screening guidelines for women living with HIV (WLHIV) have not changed since 1995.
Cervical cancer screening for WLHIV currently starts at the onset of sexual activity (usually early adolescence). A recent US study published in AIDS journal by Stier and colleagues highlights this issue and gives evidence that cervical cancer screening should be initiated in HIV-positive women at the age of 21, the same screening age recommended for women in the general population. GlobalData epidemiologists expect that the results of this study will likely impact screening recommendations in WLHIV by raising the screening age to 21 years.
In the study by Stier and colleagues, data were analysed for WLHIV between 2002 and 2016 from the HIV/AIDS Cancer Match Study, which links HIV and cancer registries in 13 US regions. Age-specific cervical cancer incidence rates were then compared among WLHIV and women in the general population. WLHIV aged 25–54 years were found to be almost four times more likely to develop the disease compared with women in the general population. In addition, cervical cancer rates among WLHIV were elevated across all age groups between ages 25–54, but no cases were detected in women aged younger than 25 years.
This same trend is supported by the most recent data from the National Institutes of Health (NIH) Surveillance, Epidemiology and End Results Programme (SEER) database, where little to no cervical cancer cases occurred in women aged younger than 20 years in 2018. Study results demonstrate, overall, that the absence of the disease in WLHIV aged younger than 25 years provides justification for starting cervical cancer screening at age 21, rather than at the onset of sexual activity typically in early adolescence. This would serve to increase the detection of the disease in WLHIV through more effective screening in high-risk age groups and spare early adolescent WLHIV from invasive cervical procedures.
This year, GlobalData epidemiologists forecast more than 13,000 diagnosed incident cases of cervical cancer and more than 8,000 diagnosed incident cases of HIV. These are expected to approach just more than 14,000 and almost 9,000 diagnosed incident cases, respectively, by 2028 (as shown in Figure 1). In the latest data release from the US Centres for Disease Control and Prevention (CDC), in 2018, only 64% of women aged 21–24 years were screened for cervical cancer (a Pap smear within the past three years), in contrast with 84% of women aged 25–44 years. Should screening recommendations change for WLHIV in the near future, this may translate to an uptick in screening rates for women aged 21–24 years due to better-targeted screening recommendations for the relevant age groups.
While Stier and colleagues highlight major concerns in the WLHIV population, more research is needed before any guidelines are changed. In the future, researchers should focus on conducting larger, multi-centre studies to better understand and elaborate on the findings from this study.